應用共享決策於末期腎臟疾病病人腎臟替代療法的決策衝突

Applying Shared Decision Making With End-Stage Renal Disease Patients Undergoing Renal Replacement Therapy to Reduce Decision Making Conflicts

10.6224/JN.201908_66(4).12

何雅芳(Ya-Fang HO)；林秋菊(Chiu-Chu LIN)

末期腎臟疾病 ； 共享決策 ； 決策衝突 ； 腎臟替代療法 ； end-stage renal disease ； shared decision-making ； decisional conflict ； renal replacement therapy

護理雜誌

66卷4期（2019 / 08 / 01）

95 - 102

繁體中文

共享決策是台灣近年新興的臨床醫療決策模式，此模式可讓病人了解不同的治療方案可能帶來的益處、傷害和風險，讓最終的選擇更符合自己的價值觀及偏好，進而降低其決策衝突。高品質的醫療服務雖使得末期腎臟疾病病人得到良好的醫療照護而提升其存活率，但也使得病人須面對腎臟替代療法的選擇。腎臟替代療法有不同的治療方式；每一種治療方式可能都對身體造成衝擊，也可能會影響其未來日常生活的變動程度，以及工作、社會角色能否延續等問題。面對這種須終身相伴的治療方式選擇，病人常感受到矛盾、不確定與猶豫而難以做出決定。本文論述末期腎臟疾病病人面臨腎臟替代療法的決策衝突及其影響因素，提出腎臟替代療法的共享決策模式，以供臨床健康專業人員照護病人時之參考。

The shared decision making (SDM) is an innovative, emerging clinical medical decision model in Taiwan. This model allows patients to understand the possible benefits, hazards, and risks of different treatment options and to choose the treatment option that best aligns with their values and preferences, thereby reducing patients' decisional conflicts. The survival rate of patients with end-stage renal disease (ESRD) has improved, in part due to the rapid development of medical technologies and treatment modalities. However, survival requires that patients face the choice conflicts associated with renal replacement therapy. All of the various renal replacement therapy treatment options impact the physical state of patients, cause changes in their daily life, and undermine their normal work and social roles. Patients often deal with conflict, uncertainty, and hesitation when they engage in making decisions about renal replacement therapy, as the course of treatment is long-term and the effects accompany the patients for the remainder of their life. This article discusses the decisional conflicts of ESRD patients in renal replacement therapy and its influencing factors. The authors propose the SDM approach to renal replacement therapy as a care reference for clinical health professionals.

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